Single lung/lobe ventilation endotracheal tube

ABSTRACT

Techniques for single lung ventilation (SLV) include a hollow main tube with outer diameter sized to fit inside a bronchus of a patient. The length of the main tube is sufficient for a distal end of the main tube to reach a first side bronchus from a proximal end configured to be located in a vicinity of a mouth of the patient. The hollow main tube has a ventilating orifice separated from the distal end at a location that corresponds to a different second side bronchus. A hollow tubular sleeve is moveably disposed inside and longitudinally aligned with the main tube. The sleeve is configured to be positioned in at least two positions: a first position that does not block the ventilating orifice; and, a second position that does block the ventilating orifice.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a CONTINUATION-IN-PART of U.S. patent applicationSer. No. 13/746,583 filed Jan. 22, 2013, which claims benefit ofProvisional Application 61/589,335, filed Jan. 21, 2012, the entirecontents of which are hereby incorporated by reference as if fully setforth herein.

BACKGROUND OF THE INVENTION

Single lung ventilation (SLV) is performed in patients undergoingthoracic surgery in order to cause deflation of the operative lung,thereby improving surgical conditions. Lung deflation allows for bettervisualization of structures in the chest, prevents intermittentexpansion of the lung during ventilation (impairing access tointra-thoracic structures and interfering with surgical manipulation)and obviates the need for surgical retraction of the lung, which maycause trauma to the lung parenchyma. There are currently three methodsof performing SLV in children: (1) placement of a conventionalendotracheal tube (ETT) into the mainstem bronchus on the non-operativeside (also called the side of the ventilated lung); (2) insertion of aballoon wedge catheter (bronchial blocker) into the mainstem bronchus onthe operative side (also called the side of the operative lung); and (3)tracheal intubation with a double-lumen ETT (DLT). Each of these hasseveral disadvantages.

SUMMARY OF THE INVENTION

Techniques are provided for single lung or lobe ventilation with anadvanced endotracheal tube, referenced hereinafter as an advanced SLVETT.

In a first set of embodiments, an apparatus includes a hollow main tubeand a hollow tubular sleeve. The main tube has an outer diameter sizedto fit inside a bronchus of a patient and a length sufficient for adistal end of the main tube to reach a first side bronchus from aproximal end configured to be located in a vicinity of a mouth of thepatient. The main tube has a ventilating orifice separated from thedistal end at a location that corresponds to a different second sidebronchus. The sleeve is moveably disposed inside and longitudinallyaligned with the main tube. The sleeve is configured to be positioned inat least two positions: a first position that does not block theventilating orifice; and, a second position that does block theventilating orifice.

In a second set of embodiments, a method includes selecting the aboveapparatus sized for a patient and causing the sleeve to be at the firstposition. The method also includes inserting the distal end of the maintube into the bronchus of a ventilating lobe of a lung of the patient sothat the ventilating orifice faces a bronchus of a different, operativelobe of a lung of the patient. The method further includes connectingthe proximal end of the main tube to a ventilation source, and movingthe sleeve to the second position.

Still other aspects, features, and advantages of the invention arereadily apparent from the following detailed description, simply byillustrating a number of particular embodiments and implementations,including the best mode contemplated for carrying out the invention. Theinvention is also capable of other and different embodiments, and itsseveral details can be modified in various obvious respects, all withoutdeparting from the spirit and scope of the invention. Accordingly, thedrawings and description are to be regarded as illustrative in nature,and not as restrictive.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention is illustrated by way of example, and not by wayof limitation, in the figures of the accompanying drawings and in whichlike reference numerals refer to similar elements and in which:

FIG. 1A is a block diagram that illustrates example use of a standardendotracheal tube for single lung ventilation (SLV);

FIG. 1B is a photograph that illustrates an example balloon tippedendobronchial catheter sometimes used for single lung ventilation (SLV);

FIG. 1C is a photograph that illustrates an example double lumenbronchial tube (DLT) sometimes used for single lung ventilation (SLV);

FIG. 2A and FIG. 2B are block diagrams that illustrate an exampleadvanced single lung ventilation endotracheal tube (SLV ETT) in open andclosed configurations, respectively, according to an embodiment;

FIG. 2C is a block diagram that illustrates an example cross sectionnear the proximal end of the SLV ETT of FIG. 2A and FIG. 2B, accordingto an embodiment;

FIG. 3A and FIG. 3B are block diagrams that illustrate an exampleadvanced SLV ETT in open and closed configurations, respectively,according to another embodiment;

FIG. 3C is a block diagram that illustrates an example cross sectionnear the proximal end of the SLV ETT of FIG. 3A and FIG. 3B, accordingto this embodiment;

FIG. 4A and FIG. 4B are block diagrams that illustrate an SLV ETTdeployed in a patient in open and closed configurations, respectively,according to an embodiment;

FIG. 5 is a block diagram that illustrates an single lobe ventilationETT, according to yet another embodiment;

FIG. 6 is a flow chart that illustrates an example method for singlelung ventilation (SLV), according to an embodiment;

FIG. 7A and FIG. 7B are block diagrams that illustrate an exampleadvanced single lung ventilation endotracheal tube (SLV ETT) without andwith an outer tube handle, respectively, according to embodiments of theinvention; and

FIG. 7C is a block diagram that illustrates a close up view of the aportion of the SLV ETT, according to embodiments of the invention.

DETAILED DESCRIPTION

A method and apparatus are described for single lung or lobeventilation. In the following description, for the purposes ofexplanation, numerous specific details are set forth in order to providea thorough understanding of the present invention. It will be apparent,however, to one skilled in the art that the present invention may bepracticed without these specific details. In other instances, well-knownstructures and devices are shown in block diagram form in order to avoidunnecessarily obscuring the present invention.

Some embodiments of the invention are described below in the context ofventilating only the left lung using inflatable cuffs so the right lungcan be subject to some procedure. However, the invention is not limitedto this context. In other embodiments the operative and ventilated lungsare switched, or one or more lobes of one lung are ventilated whileother lobes of the same lung are subjected to some operative procedurewhile not-ventilated, or the main tube diameter is such that one or bothof the tracheal and bronchial cuffs may be omitted, or the apparatus oruse is modified in some combination of ways.

1. Overview

FIG. 1A is a block diagram that illustrates example use of a standardendotracheal tube (ETT) for single lung ventilation (SLV). Theendotracheal tube (ETT) 110 includes a cuff 112 and is inserted throughthe trachea 190 into a branch of the bronchi 192. The bronchi 192include upper lobe bronchi 193 in each lung. Viewing the patient fromthe front, the patient's left lung is the ventilated lung 198 in thisconfiguration, and the patient's right lung is the operative lung 199that is not ventilated. The non-ventilated lung will deflate due toabsorption atelectasis, as indicated by the irregular outline and darkshading.

FIG. 1A depicts one deficiency of using a standard ETT. Because thedistance from the cuff 112 to the distal end of the ETT is set forventilating both lungs at the mainstem branch of the bronchi, thisdistance might exceed the distance from the mainstem branch to the upperlobe bronchus 193 of the ventilated lung. This might prevent properventilation of the upper lobe of the ventilated lung and decrease thetotal ventilation delivered to the patient. Thus not only does theoperative lung deflate, but the upper lobe of the ventilated lung alsodeflates (indicated by irregular shape and dark shading). Thus,hypoxemia may occur because of obstruction of the upper lobe bronchus.

A smaller, uncuffed ETT might not provide an adequate seal of theintubated bronchus. This may prevent the operative lung from adequatelydeflating. In patients with unilateral lung infection, this may fail toprotect the healthy, ventilated lung from contamination by purulentmaterial from the contralateral lung.

Whether a cuffed or uncuffed ETT is used, the operative lung cannot besuctioned with this technique.

A further disadvantage arises because use of a conventional ETT requiresintraoperative repositioning of the ETT. The ETT must be un-taped,advanced into a mainstem bronchus to facilitate SLV and then re-taped;it then must be un-taped again and pulled back into the trachea tofacilitate re-expansion of the deflated lung and bilateral lungventilation. These maneuvers present the risk of inadvertent andpotentially catastrophic tracheal extubation during surgery as well asincreased risk of damage to the larynx and walls of the trachea andbronchi.

FIG. 1B is a photograph that illustrates an example balloon tippedendobronchial catheter 120 sometimes used for single lung ventilation(SLV). The device includes a catheter 122 with a tip 121 at a distalend. Near the tip 121 is an inflatable balloon 124 used to occlude abronchus in which the tip is placed. The balloon is inflated in place bymeans of a tube inside the catheter 122. In some devices, the catheter122 is hollow and the tip 121 has an opening to form an optional lumen123.

When closed tip bronchial blockers are used with a conventional ETT; thedistal end of the ETT is inserted to the mainstem branch after theballoon catheter is guided into the bronchus of the operative lung. Theballoon is, then inflated to occlude the bronchus. In thisconfiguration, the operative lung cannot be suctioned; and, oxygen andcontinuous positive airway pressure cannot be provided to the operativelung. Therefore, some practitioners prefer to use a bronchial blockerwith an internal lumen and end-hole for SLV, as oxygen and suction maybe administered via the lumen. Both types of endobronchial catheters arecommonly placed outside of the ETT. Such placement requires delicatemanipulation and the tracheal mucosa may be damaged by pressure exertedby the combination of the bronchial blocker and ETT. The bronchialblocker cannot be readily repositioned during surgery if it becomesdislodged.

Adapters have been used that facilitate placement of a bronchial blockerthrough an indwelling ETT. The risk of mucosal injury may be diminished,and repositioning of the blocker may be performed with fiber opticguidance during surgery. Problems with bronchial blocker placementthrough the ETT include interference with passage of a suction catheterand effective reduction of the ETT lumen (inner) diameter, compromisingventilation.

Another disadvantage with bronchial blockers is that most practitionersuse fiber optic bronchoscopes to confirm the position of DLTs followingplacement of DLTs, whenever feasible. These instruments are expensive topurchase and their sterilization and maintenance is also costly.Alternatively, fluoroscopy may be used to confirm blocker position. Theuse of fluoroscopy represents significant time and expense as well asradiation exposure to the patient and operating room personnel.

FIG. 1C is a photograph that illustrates an example double lumenbronchial tube (DLT) 130 sometimes used for single lung ventilation(SLV). The DLT includes two separate D-shaped lumens 132 a and 132 b,one of which connects to a bronchial tube 136, which may include abronchial cuff. A tracheal cuff 134 is apparent in FIG. 1C.

The use of DLTs is common in adult patients undergoing thoracic surgery.DLTs consist of a tube divided into two “D”-shaped lumens 132 a and 132b. The advantages of DLT use include the ability to isolate orselectively ventilate each lung. Disadvantages include the relativestiffness and large outer diameter of these ETTs, which may present therisk of tracheal or bronchial injury. In addition, the largest roundobject, such as a suction catheter or fiber optic bronchoscope, thatwill pass down each lumen (i.e. the “working diameter”) is relativelysmall. DLTs cannot be used in children under the age of about 10 years,as the working diameter of the lumens would be too small to allowadequate ventilation as well as passage of a suction catheter. The costof purchase and maintenance of fiber optic bronchoscopes associated withbronchial blocker use also applies to DLTs.

The advanced SLV ETT represents a novel design for single lung or lobeventilation that may be applied even to small children. The innovativeand unique features that address the limitations of each of the threeestablished methods for SLV include a sleeve inside a main tube and asecondary ventilating orifice in the main tube. The sleeve or innercannula may be constructed of very thin material, thereby minimizing thefunctional reduction of the inner diameter of the ETT. This featureallows for optimal ventilation and passage of relatively large suctioncatheters compared to internally placed bronchial blockers or a DLT. Asan improvement over the DLT, an inner diameter of the sleeve is greaterthan 50% of the outer diameter of the main tube, and preferably greaterthan 50% of the diameter of the target bronchus. To provide an evengreater advantage, in some embodiments, the inner diameter of the sleeveis greater than about 80% of the outer diameter of the main tube orinner diameter of the bronchus. The secondary ventilating orifice isdirected at the bronchus on the operative side, such as a differentmainstem bronchus. When the sleeve is in a first position (e.g., “OPEN”position), the orifice is open and both lungs or lobes can beventilated. When the sleeve is in a second position (e.g., “CLOSED”position), the orifice is occluded, the operative lung or lobe is notventilated, and ventilation is confined to the non-operative (e.g., the“ventilated”) lung or lobe or lobes.

The sleeve is disposed in the main tube. The main tube outer diameter islimited by the inner diameter of the bronchus into which it is to beinserted. Thus the main tube is made available in a variety of sizes forpatients of different ages and different adult sizes, such as with aninner diameter selected from a group of diameters in a range of innerdiameters from about 3.5 millimeters (mm, 1 mm=10-3 meters) to about 9mm, such as 3.5 mm, 4.0 mm, 4.5 mm, 5.0 mm, 5.5 mm, 6.0 mm, 6.5 mm, 7.0mm, 7.5 mm, 8.0 mm, 8.5 mm and 9.0 mm. The main tube has a lengthsufficient for a distal end of the main tube to reach a target bronchusin the patient from a proximal end configured to be located in avicinity of a mouth of the patient. Thus, the main tube is available incorresponding lengths selected from a group of lengths in a range oflengths from about 22 cm (for the pediatric 3.0 mm inner diameter tube)to 34 cm (for the largest adult 9.0 mm inner diameter tube. The maintube provides the structural integrity and is constructed from any ofseveral appropriate materials selected so that the main tube is flexibleenough to follow the trachea and bronchi to the target bronchus in thepatient. For example, in various embodiments, the main tube isconstructed of material used in standard ETTs with similar wallthickness and inner diameters. Such materials and thicknesses includeplastic (polyvinyl chloride) and other polymers with a wall thicknessbetween 1.2 mm for the smaller (pediatric) tubes and 3.2 mm for thelarger (adult) tubes. In some embodiments, the main tube or sleeve orboth are tapered to be one size at the proximal end and a smaller sizetoward the distal end.

In some embodiments, an external structure (e.g., an outer ring) isattached to the sleeve, with which the sleeve may be moved easilybetween the “CLOSED” position and the “OPEN” position, to occlude orexpose, respectively, the secondary ventilating orifice. In someembodiments, the external structure (e.g., the ring) is near the ETTproximal end and is readily accessible to the practitioner (e.g., ananesthetist) during surgery.

In some embodiments, an inflatable bronchial or tracheal cuff isincluded. The inflatable bronchial cuff or tracheal cuff is a short,low-pressure, high-volume structure. Such a cuff minimizes thelikelihood of both inadvertent occlusion of a bronchus (such as theupper lobe bronchus of the ventilated lung) and also mucosal injury. Insome embodiments the bronchial or tracheal cuff, or both, is notinflated but is made of a soft material that provides an effectivelyairtight seal. As used herein, the adjective airtight indicatessubstantially inhibiting the passage of any gas, including air, e.g.,around the cuff at inflating pressures up to about 30 centimeters ofwater (cm H2O) to about 35 cm H2O.

In contrast to bronchial blockers and DLTs, placement of the SLV ETT isrelatively simple. No special equipment (such as fiber opticbronchoscope or fluoroscopy) is required. Following tracheal intubation,prior to taping in place, the SLV ETT is advanced until breath soundsare lost on the operative side; it is then pulled back until breathsounds are restored and then the tube is taped at this depth. Norepositioning of the ETT is required once its initial position isconfirmed, in contrast to use of a conventional ETT (as describedabove). If oxygenation of the operative lung is desired during SLV, thesleeve may be partially moved, allowing a narrow stream of oxygen toflow to the deflated lung without causing lung expansion. Alternatively,the orifice can be opened further while a brief period of continuouspositive airway pressure (CPAP) is applied; oxygenation can be restoredwithout full inflation or ventilation of the operative lung. Again, norepositioning of the ETT itself is required during such maneuvers.Suctioning of the trachea while the sleeve is in the “OPEN” position, orpartially open position, will allow evacuation of secretions and bloodfrom the operative lung, even during surgery and lung deflation, incontrast to use of a conventional ETT.

2. Example Embodiments

FIG. 2A and FIG. 2B are block diagrams that illustrate an exampleadvanced single lung ventilation endotracheal tube (SLV ETT) in openconfiguration 200 a and closed configurations 200 b, respectively,according to an embodiment. This embodiment of the SLV ETT itself ishenceforth designated SLV ETT 200 and component elements are describedin configuration 200 a.

The SLV ETT 200 comprises a main tube 210 with a length sufficient for adistal end 214 of the main tube to reach a target bronchus in thepatient from a proximal end configured to be located in a vicinity of amouth of the patient. The main tube is hollow and provides a main lumen211 to provide passage for the sleeve as well as ventilation (gas supplyor effective suction), and the passage of one or more devices, such asballoon catheters through the distal end. In addition to the opening ofthe lumen at the distal end 214, is a secondary ventilating orifice 216.The ventilating orifice 216 is separated from the distal end 214 at alocation that corresponds to a different second bronchus, when thedistal end is placed into the target bronchus.

In this configuration the portion of the lung connected through thetarget bronchus is the ventilated lung or lobe (also called thenon-operative lung or lobe). The portion of the lung connected throughthe different second bronchus is the operative lung or lobe (also calledthe non-ventilated lung or lobe). In an illustrated embodiment, thetarget bronchus is the left mainstem bronchus to ventilate the left lungand the second bronchus is the right mainstem bronchus to operate on theright lung. But in another embodiment, the target bronchus is the lowerleft lobe bronchus and the second bronchus is the upper left lobebronchus. In some of these embodiments, another ventilating orifice isprovided in the main tube to ventilate a third bronchus, such as theright mainstem bronchus, as described in more detail below withreference to FIG. 5. In various other embodiments, different ventilatedlobes and operative lobes are subjected to a SLV ETT.

In the illustrated embodiment, the main tube includes a ventilationadapter 212 at the proximal end. The ventilation adaptor 212 isconfigured to be connected to a ventilation apparatus for providing gasat positive pressure or suction at a negative pressure. In variousembodiments, any ventilating apparatus may be used with a correspondingadaptor on the proximal end of the main tube. Thus, an adaptor affixedto the proximal end of the main tube is configured for attachment to aventilation source.

SLV ETT 200 includes a tube-shaped sleeve 220 that fits inside the maintube 210. Thus the outer diameter of sleeve 220 is less than the innerdiameter of main tube 210. In the illustrated embodiment, the fit issnug enough to stay in place but loose enough to allow ready movement ofthe sleeve 220 relative to the tube 210. Thus, the sleeve 220 ismoveably disposed inside and longitudinally aligned with the main tube210. Because the inner sleeve 220 need not provide structural integrity,in various embodiments, the sleeve 220 is made of a thin material thatcan withstand physiological pressures applied to the ventilated lung orlobe. This allows the lumen 221 of the sleeve 220 to be as large aspossible, for the most effective ventilation or passage of one or moreother devices into the target bronchus, or some combination. The sleeveis configured to be positioned in at least two positions, a firstposition that does not block the ventilating orifice 216 and a secondposition that does block the ventilating orifice 216.

To control movement of the sleeve 220 relative to the main tube 210, aconnector is provided to an external structure that can be accessedeasily by an operator, such as an anesthesiologist. For example, in SLVETT 200, a connector 236 attached to sleeve 220 passes through a slit218 in the main tube to an outer ring 230 near the proximal end of themain tube. Thus, an external structure connected to the sleeve by aconnecting element is configured to move the sleeve between the firstposition and the second position; and, the connecting element ismoveably disposed in a slit in the main tube. In some embodiments theslit includes one or more notches that engage the connector and inhibitmovement of the connector along the slit without pressure applied by anoperator.

The outer ring is configured to be airtight, e.g., to preventsignificant leakage of gas between the main lumen 211 and the ambientair. In some embodiments, the length of the ring 230 is selected so thatsufficient contact between ring 230 and main tube 210 preventssignificant exchange of gas. In the illustrated embodiment, the interiorof ring 230 or exterior of main tube 210 is configured with one or moregaskets (such as gasket 234 a and gasket 234 b, collectively referencedhereinafter as gaskets 234) to allow no, or only negligible, exchange ofgas between the main lumen 211 and the ambient air. In some embodiments,the ring 230 is omitted and the slit 218 includes an airtight gasketthrough which the connector 236 can be moved by operator contact with anexternal projection or handle of the connector 236.

In some embodiments, the SLV ETT includes a bronchial cuff 242 ortracheal cuff 240 or both. The cuffs are configured to block theexchange of gas outside the main tube 210, especially when the bronchusor trachea, or both, has a larger inner diameter than the outer diameterof the main tube between the distal end of the main tube emplaced in thepatient's target bronchus and the patient's mouth. The cuffs 240 and 242are made of any pliable material that can conform to the inner surfaceof the trachea or bronchus, respectively, and inhibit the flow of gas.For example, the same material currently used in a cuff for aconventional ETT or DLT is used in some embodiments. In someembodiments, the cuffs 240 or 242 or both are balloons cuffs that can beinflated to conform to the inner surface of the trachea or bronchus,respectively, and inhibit the flow of gas. In some embodiments, eachballoon cuff is fed by a thin tube that runs along the outer edge of themain tube 210 and diverges near the proximal end of the main tube toconnect to a pilot balloon (not shown).

In some embodiments, the bronchial cuff 242 is displaced from the distalend 214 of the main tube to a location that corresponds to a locationbetween the target bronchus and the second bronchus. Thus, the bronchialcuff 242 is disposed on the main tube 210 between the distal end 214 andthe ventilating orifice 216. In some embodiments, the tracheal cuff 240is displaced from the distal end 214 of the main tube to a location thatcorresponds to a location between the second bronchus and the nextlarger bronchus, such as the trachea. Thus, the tracheal cuff 240 isdisposed on the main tube between the proximal end and the ventilatingorifice 216.

In some embodiments, the sleeve 220 in the second position blocks theventilating orifice 216 with an airtight seal. In the illustratedembodiment, the sleeve includes one or more gaskets, such as gasket 224a and gasket 224 b (collectively referenced hereinafter as gaskets 224)to provide an airtight seal when the sleeve is in the second position.Any suitable material may be used for gaskets 224, such as rubber. Thus,the sleeve is configured to form an airtight seal at ventilatingpressures with the main tube surrounding the ventilating orifice whenthe sleeve is in the second position.

FIG. 2A depicts SLV ETT 200 a configured in a first position in whichthe ventilating orifice 216 is not blocked by the sleeve 220. FIG. 2Bdepicts SLV ETT 200 b configured in a second position in which theventilating orifice 216 is blocked by the sleeve 220. All components inFIG. 2B are already described above with reference to FIG. 2A. When thesleeve is moved to the second position, e.g., by an operator moving ring230 downward toward the distal end 214, the orifice 216 is blocked bythe sleeve 220. The gaskets 224 ensure an airtight seal. Thus, thesleeve is displaced longitudinally toward the distal end in the secondposition compared to the first position. In some embodiments, the sleeve220 or connector 236 or slit 218 is configured so the sleeve 220 can bestopped in one or more positions between the first position and thesecond position so as to block the ventilating orifice 216 onlypartially. Thus, in such embodiments, the sleeve is further configuredto be positioned in a third position that partially blocks theventilating orifice.

FIG. 2C is a block diagram that illustrates an example cross sectionnear the proximal end of the SLV ETT 200 of FIG. 2A and FIG. 2B,according to an embodiment. The inner sleeve 220 fits inside the maintube 210. A connector 236 connects the sleeve 220 to the outer ring 230through the longitudinal slit 218 in the main tube 210. The sleeve lumendiameter 252, which is the inner diameter of sleeve 220, is smaller thanthe main tube outer diameter 250, but the sleeve lumen diameter 252 ismuch greater than 50% of that diameter 250. In the illustratedembodiment, the sleeve lumen diameter 252 is about 80% of the main tubeouter diameter. Thus, when the main tube is snug in the trachea orbronchus, the sleeve lumen is about 80% of the natural lumen, providingimproved ventilation (including gas supply and suction) and access.

FIG. 3A and FIG. 3B are block diagrams that illustrate an exampleadvanced SLV ETT in open configuration 300 a and closed configuration300 b , respectively, according to another embodiment. This embodimentof the SLV ETT itself is henceforth designated SLV ETT 300 and componentelements are described in configuration 300 a. Ventilator adaptor 212,gasket 234 a, gasket 234 b, tracheal cuff 240, ventilating orifice 216,main lumen 211, bronchial cuff 242 and distal end 214 are as describedabove with reference to FIG. 2A. Main tube 310 includes an azimuthalslit 318 in place of the longitudinal slit 218 of SLV ETT 200. Connector336 is configured to move through azimuthal slit 318 and outer ring 330is configured to be rotated relative to the main tube 310 rather thanmoved longitudinally. Sleeve 320 has an azimuthally dependent length anda differently configured gasket 324 to provide for airtight blockage ofventilating orifice 216.

FIG. 3A depicts SLV ETT 300 a configured in a first position in whichthe ventilating orifice 216 is not blocked by the sleeve 320. FIG. 3Bdepicts SLV ETT 300 b configured in a second position in which theventilating orifice 216 is blocked by the sleeve 320. All components inFIG. 3B are already described above with reference to FIG. 3A. When thesleeve is moved to the second position, e.g., by an operator rotatingring 330 azimuthally, the orifice 216 is blocked by the sleeve 320. Thegasket 324 ensures an airtight seal. Thus, the sleeve is rotated in thesecond position compared to the first position. In some embodiments, thesleeve 320 or connector 336 or slit 318 is configured so the sleeve 320can be stopped in one or more positions between the first position andthe second position so as to block the ventilating orifice 216 onlypartially. Thus, the sleeve is further configured to be positioned in athird position that partially blocks the ventilating orifice.

In other embodiments other movements of the sleeve are utilized. Forexample in some embodiments, the slit is aligned with both longitudinaland azimuthal displacements; and, the ring is both rotated and movedlongitudinally to move between the first position and the secondposition.

FIG. 3C is a block diagram that illustrates an example cross sectionnear the proximal end of the SLV ETT 300 of FIG. 3A and FIG. 3B,according to this embodiment. The inner sleeve 320 again fits inside themain tube 310. A connector 336 connects the sleeve 320 to the outer ring330 through the azimuthal slit 318 in the main tube 310. The sleevelumen diameter 352, which is the inner diameter of sleeve 320, issmaller than the main tube outer diameter 350, but the sleeve lumendiameter 352 is much greater than 50% of that diameter 350. In theillustrated embodiment, the sleeve lumen diameter 352 is about 80% ofthe main tube outer diameter 350. Thus, when the main tube is snug inthe trachea or bronchus, the sleeve lumen is still about 80% of thenatural lumen, again providing improved ventilation (including gassupply and suction) and access, compared to other devices used for SLV.

FIG. 4A and FIG. 4B are block diagrams that illustrate an SLV ETTdeployed in a patient in open configuration 400 a and closedconfiguration 400 b, respectively, according to an embodiment. Thisembodiment of the SLV ETT itself is henceforth designated advanced SLVETT 400 and component elements are described in configuration 400 a. SLVETT 400 is similar to SLV ETT 200 with longitudinally moving sleeve 220;but, SLV ETT includes inflatable tracheal cuff 440 and inflatablebronchial cuff 442, with corresponding pilot balloons 444 a, 444 b andcatheters 446 a, 446 b, respectively, used with inflatable cuffs. Themain tube 410 with ventilating orifice 416 is depicted along withventilation adaptor 412, and sleeve 420. The distal end of main tube 410and bronchial cuff 442 are disposed in the left mainstem bronchus of thebronchi 492 of the patient. The tracheal cuff 440 is disposed in thetrachea 490 of the patient. The ventilating orifice 416 is facing thepatient's right mainstem bronchus.

In FIG. 4A, the outer ring is in open position 430 a, the sleeve 420 hasa retracted distal end 223 a, the ventilating orifice is not blocked,and gas or air flow 480 is freely directed into the right mainstembronchus as well as through the distal end of the main tube 410 into thepatient's left mainstem bronchus. In FIG. 4B, the outer ring is inclosed position 430 b, the sleeve 420 has a longitudinally extendeddistal end 223 b, the ventilating orifice 416 is blocked, and gas or airflow into the right mainstem bronchus is absent, while air flows freelyinto the left mainstem bronchus. The patient's right lung (on viewer'sleft) will deflate as is suitable for certain operations on thepatient's right lung, while the patient's left lung remains ventilated.

FIG. 5 is a block diagram that illustrates a SLV ETT 500 for operatingon a single lobe, according to yet another embodiment. This SLV ETT 500ventilates lobes both upstream and downstream of the operative lobe. TheSLV ETT 500 includes a ventilation adaptor 212, main lumen 211, distalend 214, slit 218, ring 230, connector 236, gasket 234 a, gasket 234 b,gasket 224 a, gasket 224 b, ventilating orifice 216, sleeve lumen 221,tracheal cuff 240 and bronchial cuff 242 as described above withreference to FIG. 2A. However, this embodiment includes a main tube 510with another ventilating orifice 516 to ventilate a bronchus upstream ofthe operative lobe. To keep this orifice open even when the orifice 216is blocked, tubular inner sleeve 520 includes a sleeve opening 526 thatprevents blockage of the orifice 516 when the sleeve is movedlongitudinally. The second cuff is a second bronchial cuff 540configured for positioning inside a bronchus instead of the trachea.This embodiment provides the advantage of isolating the operative lobefrom upstream lobes.

In the open configuration depicted, gas, such as air, flows freelythrough the main lumen 211 at the distal end 214 of the main tube 510 aswell as through the ventilating orifice 216 and the other ventilatingorifice 516. In the closed configuration, the sleeve 520 blocksventilating orifice 216, with gaskets 224 and 224 b providing anairtight seal. However, air flows freely through the distal end 214 andthe other ventilating orifice 516. Referring to FIG. 1A, the SLV ETT500, when in the closed configuration, is capable of ventilating thepatient's entire right lung through the other ventilating orifice 516and the lower lobe of patient's left lung through the distal end 214 ofthe main tube, while not ventilating the upper lobe of the patient'sleft lung. Thus, a surgical procedure can be performed in the vicinityof the upper lobe of the patient's left lung.

FIG. 7A and FIG. 7B are block diagrams that illustrate an exemplaryadvanced single lung ventilation endotracheal tube (SLV ETT) 700 withoutand with an outer ring/outer tube handle, respectively. FIG. 7C is ablock diagram that illustrates a close up view of the outer ring 230 andportions of the SLV ETT 700 proximate to outer ring 230 shown in FIGS.7A and 7B.

The SLV ETT 700 comprises a main tube 210 with distal end 214, secondventilating orifice 216, pilot balloons 444 a and 444 b, pilot ballooncatheters 446 a and 446 b, an outer ring retention notch 710, a maintube handle 715, outer ring 230, sleeve 220, slits 218, connector 236,and an adaptor 705. The main tube 210 may have a length sufficient for adistal end 214 of the main tube 210 to reach a target bronchus in thepatient from a proximal end configured to be located in a vicinity of amouth of the patient.

The main tube 210 is hollow and provides a lumen that allows for passagefor the sleeve 220 as well as ventilation (gas supply or effectivesuction) and the passage of one or more devices, such as ballooncatheters through the distal end 214. In some embodiments, the sleeve220 may be sized and positioned within the lumen of main tube 210 sothat air, or other gases, cannot pass between sleeve 220 and main tube210. Additionally, or alternatively, a lubricant or coating (e.g., ahydrophobic coating) may be applied to an exterior surface of sleeve220, an interior surface of main tube 210, or both so as to, forexample, facilitate sliding, or otherwise moving, sleeve 220 relative tomain tube 210. In addition to the opening of the lumen at distal end 214(which provides a first, or primary, ventilating orifice), main tube 210may also include a second, or secondary, ventilating orifice 216 and anoptional third ventilating orifice 516, (also referred to herein as“another ventilating orifice 516”) both of which may be positioned nearthe distal end 214. The third ventilating orifice 516 may be used toventilate a bronchus upstream of the operative lobe. To keep this thirdventilating orifice 516 open even when the secondary orifice 216 isblocked, sleeve 220 may include a sleeve opening (not shown) thatprevents blockage of the third ventilating orifice 516 when the sleeve220 is moved longitudinally. This embodiment provides the advantage ofisolating the operative lobe from upstream lobes.

When SLV ETT 700 includes a third ventilating orifice 516, gas, such asair, may flow freely through the lumen of main tube 210 at the distalend 214 of the main tube 210 as well as through the secondaryventilating orifice 216 and the third ventilating orifice 516. In theclosed configuration, the sleeve 220 may block the second ventilatingorifice 216 and provide an airtight seal. However, air may flow freelythrough the distal end 214 and the third ventilating orifice 516.Referring to FIG. 1A, the SLV ETT 700, when in the closed configuration,is capable of ventilating the patient's entire right lung through thethird ventilating orifice 516 and the lower lobe of patient's left lungthrough the distal end 214 of the main tube, while not ventilating theupper lobe of the patient's left lung. Thus, a surgical procedure can beperformed in the vicinity of the upper lobe of the patient's left lung.

In this configuration the portion of the lung connected through thetarget bronchus is the ventilated lung or lobe (also called thenon-operative lung or lobe). The portion of the lung connected throughthe different second bronchus is the operative lung or lobe (also calledthe non-ventilated lung or lobe). In an embodiment, the target bronchusis the left mainstem bronchus to ventilate the left lung and the secondbronchus is the right mainstem bronchus to operate on the right lung.But in another embodiment, the target bronchus is the lower left lobebronchus and the second bronchus is the upper left lobe bronchus. Insome of these embodiments, another ventilating orifice (not shown) isprovided in the main tube to ventilate a third bronchus, such as theright mainstem bronchus, as described in more detail above withreference to FIG. 5. In various other embodiments, different ventilatedlobes and operative lobes are subjected to a SLV ETT like SLV ETT 700.

SLV ETT 700 includes a tube-shaped sleeve 220 that fits inside the maintube 210. Thus the outer diameter of sleeve 220 is less than the innerdiameter of main tube 210. In the illustrated embodiment, the fit issnug enough to stay in place but loose enough to allow ready movement ofthe sleeve 220 relative to the tube 210. Thus, the sleeve 220 ismoveably disposed inside, and longitudinally aligned with, the main tube210. Because the inner sleeve 220 need not provide structural integrity,in various embodiments, the sleeve 220 is made of a thin material thatcan withstand physiological pressures applied to the ventilated lung orlobe. This allows the lumen of the sleeve 220 to be as large aspossible, for the most effective ventilation or passage of one or moreother devices into the target bronchus, or some combination. The sleeve220 is configured to be positioned in at least two positions, a firstposition that does not block the ventilating orifice 216 and a secondposition that does block the ventilating orifice 216. Outer ring 230 maybe configured to facilitate movement of the sleeve 220 relative to themain tube 210, as well as enable handling of SLV ETT 700.

SLV ETT 700 may include a ventilation adaptor 705 coupled to sleeve 220.The ventilation adaptor 705 is configured to connect to a ventilationapparatus for providing gas at positive pressure or suction at anegative pressure. In various embodiments, any ventilating apparatus maybe used with a corresponding adaptor on the proximal end of the sleeve220. Thus, the ventilation adaptor 705 affixed to the proximal end ofthe sleeve 220 is configured for attachment to a ventilation source.

Sleeve 220 may also include connector 236 affixed thereto. The connector236 provided by FIGS. 7A, 7B, and 7C has two extensions that areconfigured to be positioned within two slits 218, which are positionedon either side of outer ring 230 (only one slit 218 is shown in FIGS. 7Band 7C). In this way, the extensions of the connector 236 protrudethrough slits 218 so that sleeve 220 may be moved from a first positionto a second position and/or from a second position to a third position(and vise versa) when pressure is applied to the connector 236 and/orextensions of the connector 236 by an operator, such as ananesthesiologist. In some circumstances, the operator may hold main tubehandle 715 still and apply pressure to connector 236 and/or connectorextensions to move the sleeve 220 from a first position to a secondposition and/or from a second position to a third position (and viseversa).

In some embodiments, slits 218 include one or more notches 720 thatengage the connector 236 and/or extensions of the connector 236 andinhibit movement of the connector 236 along the slits 218 withoutpressure applied by the operator. For example, slits 218 may include 3notches 720, which may correspond to a first, second, and third positionof sleeve 220 when the connector 236 and/or the connector extensions arepositioned therein. In this example, when sleeve 220 is in a firstposition, second ventilating orifice 216 may be open (i.e., sleeve 220does not occlude second ventilating orifice 216). When sleeve is in asecond position (which corresponds to the second, or middle, notch 720),second ventilating orifice 216 may be partially occluded by sleeve 220.When sleeve is in a third position (which corresponds to the third notch720, or the notch closest to distal end 214), second ventilating orifice216 may be fully occluded by sleeve 220. In some instances, the thirdposition of sleeve 220 of this embodiment may correspond to the secondposition of sleeve 220 as discussed elsewhere herein, in that whensleeve 220 is in the third position, second ventilating orifice 216 iscompletely occluded.

In some embodiments, the sleeve 220 in the second position blocks theventilating orifice 216 with an airtight seal. In some embodiments, thesleeve 220 includes one more gaskets, to provide an airtight seal whenthe sleeve 220 is in the first and/or second position. Any suitablematerial may be used for gaskets, such as rubber or plastic. Thus, thesleeve is configured to form an airtight seal at ventilating pressureswith the main tube surrounding the ventilating orifice when the sleeveis in the second position.

In some embodiments, the bronchial cuff 242 is displaced from the distalend 214 of the main tube to a location that corresponds to a locationbetween the target bronchus and the second bronchus. Thus, the bronchialcuff 242 is disposed on the main tube 210 between the distal end 214 andthe ventilating orifice 216. In some embodiments, the tracheal cuff 240is displaced from the distal end 214 of the main tube to a location thatcorresponds to a location between the second bronchus and the nextlarger bronchus, such as the trachea. Thus, the tracheal cuff 240 isdisposed on the main tube between the proximal end and the ventilatingorifice 216.

Although slits 218 are oriented in a direction substantially parallelwith that of the main tube 210 and the sleeve 220, this is notnecessarily the case. For example, slits 218 may be orientedperpendicularly or at an angle relative to main tube 210 and the sleeve220.

The main tube 210 may include the main tube handle 715, which may beconfigured to enable the operator to handle SLV ETT 700. In someembodiments, the operator may use main tube handle 715 to stabilize SLVETT 700 within a patient while applying pressure to connector 236 and/orextensions of the connector 236 so as to move the sleeve 220 from thefirst position to the second position (and vise versa).

In the illustrated embodiment, the sleeve 220 includes a ventilationadapter 705 at the proximal end. The ventilation adaptor 705 isconfigured to be connected to a ventilation apparatus for providing gasat positive pressure or suction at a negative pressure. In variousembodiments, any ventilating apparatus may be used with a correspondingadaptor 705 on the proximal end of the sleeve 220. Thus, the ventilationadaptor 705 affixed to the proximal end of the sleeve 220 is configuredfor attachment to a ventilation source.

In some embodiments, the SLV ETT 700 includes a bronchial cuff 242 ortracheal cuff 240 or both. The cuffs 242 and 240 are configured to blockthe exchange of gas outside the main tube 210, especially when thebronchus or trachea, or both, has a larger inner diameter than the outerdiameter of the main tube between the distal end of the main tubeemplaced in the patient's target bronchus and the patient's mouth. Thecuffs 240 and 242 are made of any pliable material that can conform tothe inner surface of the trachea or bronchus, respectively, and inhibitthe flow of gas. For example, the same material currently used in a cufffor a conventional ETT or DLT may be used in some embodiments. In someembodiments, the cuffs 240 or 242, or both, are balloon cuffs that canbe inflated to conform to the inner surface of the trachea or bronchus,respectively, and inhibit the flow of gas. In some embodiments, eachballoon cuff may be fed by a thin tube that runs along an outer or inneredge of the main tube 210 and diverges near the proximal end of the maintube to connect to a pilot catheter 446 a, 446 b and a pilot balloon 444a, 444 b.

3. Method

FIG. 6 is a flow chart that illustrates an example method 600 for singlelung or lobe ventilation (SLV), according to an embodiment. Althoughsteps are depicted in FIG. 6 as integral steps in a particular order forpurposes of illustration, in other embodiments, one or more steps, orportions thereof, are performed in a different order, or overlapping intime, in series or in parallel, or are omitted, or one or moreadditional steps are added, or the method is changed in some combinationof ways.

In step 601, an advanced single lung/lobe endotracheal tube (SLV ETT) isselected among a plurality of SLV ETT sizes available. The selection ismade so that an outer diameter of the distal end of the SLV ETT is nolarger than the inner diameter of a target bronchus of a lung of apatient and an inner diameter of the SLV ETT is greater than 50% of theinner diameter of the target bronchus. For example, an advanced SLV ETTis selected that has an outer diameter in a range from about 3.5 mm toabout 9 mm. The advanced SLV ETT includes a hollow main tube with outerdiameter sized to fit inside a bronchus of a patient and a lengthsufficient for a distal end of the main tube to reach a first side(e.g., target) bronchus from a proximal end configured to be located ina vicinity of a mouth of the patient. The hollow main tube has aventilating orifice separated from the distal end at a location thatcorresponds to a different second side bronchus. The advanced SLV ETTalso has a hollow tubular sleeve moveably disposed inside andlongitudinally aligned with the main tube, wherein the sleeve isconfigured to be positioned in at least two positions, a first positionthat does not block the ventilating orifice and a second position thatdoes block the ventilating orifice

In step 603, the sleeve is caused to be at the first position. Forexample, an external structure, such as a ring near the proximal end ofthe main tube, connected to the inner sleeve of the SLV ETT is operatedto position the inner sleeve in the first position to leave open theventilating orifice, e.g., by pulling the ring 230 toward the proximalend or by rotating the ring 330 to avoid blocking the ventilatingorifice 216. If the sleeve is already in the open position, then nothingis operated to cause the sleeve to be in the open position during step603.

In step 605, the distal end of the advanced SLV ETT is inserted into atarget bronchus of a ventilated lung or lobe thereof, with theventilating orifice facing an operative lung or lobe thereof. Forexample, the distal end is inserted into a patient's right mainstembronchus so that the ventilating orifice 216 is facing the patient'sleft mainstem bronchus. As another example, the distal end is insertedinto a patient's left lung lower lobe bronchus so that the ventilatingorifice 216 is facing the left lung upper lobe bronchus and anotherventilating orifice 516 is facing the right mainstem bronchus. Thus, thedistal end of the main tube is inserted into the bronchus of aventilating lobe of a lung of the patient so that the ventilatingorifice faces a bronchus of a different, operative lobe of a lung of thepatient.

In step 607, one or more bronchial cuffs or a tracheal cuff or both areinflated. For example, tracheal cuff 240 and bronchial cuff 242 areinflated using corresponding pilot balloons to regulate the volumeinflated. As another example, bronchial cuffs 242 and 540 are inflatedusing corresponding pilot balloons to regulate the volume inflated.Thus, step 607 includes, after inserting the distal end of the maintube, inflating at least one of an inflatable bronchial cuff disposedbetween the distal end of the main tube and the ventilating orifice oran inflatable tracheal cuff disposed between the proximal end of themain tube and the ventilating orifice. In embodiments without aninflatable cuff, or embodiments in which the outer diameter matches theinner diameter of the target bronchi, step 607 is omitted.

In step 609, the advanced SLV ETT is connected to ventilation equipment.For example, the ventilation adaptor 212 is connected to a pump orventilation circuit for gas supply or suction or both. Thus, theproximal end of the main tube is connected to a ventilation source. Instep 611, the ventilation equipment, e.g., a ventilation circuit isoperated for gas supply or suction or both.

In step 613 the inner sleeve is moved to at least partially block theventilating orifice facing the operative lung or lobe thereof. Forexample, an external structure, such as a handle or ring, is operated toposition the inner sleeve in a second position to close the ventilatingorifice in whole or in part. In some example embodiments, ring 230 ispushed toward the distal end of the main tube or ring 330 is rotated. Asa result of step 613, the operative lung or lobe thereof becomesdeflated. Thus, step 613 includes moving the sleeve to the secondposition or some intermediate position. In some embodiments, step 613includes moving an external structure at the proximal end of the maintube, wherein the external structure is connected to the sleeve by aconnecting element and is configured to move the sleeve between thefirst position and the second position.

In step 615, some procedure is performed on or in the vicinity of theoperative lung or lobe thereof.

In step 617 the sleeve is moved to a position to at least partiallyventilate the operative lung or lobe thereof, e.g. to suction or reflatethe lung or lobe thereof. For example, in some embodiments, an externalstructure, such as a ring or handle, is moved to retract or rotate theinner sleeve, to the first position or to an intermediate position.

In step 619, the advance SLV ETT is removed from the patient; and theprocess ends.

As can be seen by the apparatus and method above, the advanced SLV ETTrepresents a novel design for single lung or lobe ventilation that maybe applied even to small children.

4. References

The entire contents of each of the following references are herebyincorporated by reference as if fully set forth herein except forterminology that is inconsistent with that used herein.

-   -   1. Taylor C, Subaiya L, Corsino D. Pediatric cuffed endotracheal        tubes: An evolution of care. Oschner J. 2011;11(1):52-6.    -   2. Campbell C, Viswanathan S, Riopelle J M, Naraghi M.        Manufacturing defect in a double-lumen tube. Anesth Analg        1991;73:825-6]    -   3. Perel A, Katzenelson R, Klein E, Cotev S. Collapse of        endotra-cheatubes due to overinflation of high-compliance cuffs.        Anesth Analg 1977;56:731-3.    -   4. Hammer G B , Brodsky J B, Redpath J, Cannon W B: The Univent        tube for single lung ventilation in children. Pediatr Anesth        1998;8:55-57.    -   5. Hammer G B, Harrison T K, Vricella L A, Black M D, Krane E J:        Single lung ventilation in children using a new pediatric        bronchial blocker. Pediatric Anesthesia 2002;12:69-72.        5. Alternatives and extensions

In the foregoing specification, the invention has been described withreference to specific embodiments thereof. It will, however, be evidentthat various modifications and changes may be made thereto withoutdeparting from the broader spirit and scope of the invention. Thespecification and drawings are, accordingly, to be regarded in anillustrative rather than a restrictive sense. Throughout thisspecification and the claims, unless the context requires otherwise, theword “comprise” and its variations, such as “comprises” and“comprising,” will be understood to imply the inclusion of a stateditem, element or step or group of items, elements or steps but not theexclusion of any other item, element or step or group of items. elementsor steps. Furthermore, the indefinite article “a” or “an” is meant toindicate one or more of the item, element or step modified by thearticle.

What is claimed is:
 1. An apparatus for single lung ventilation,comprising: a hollow main tube with outer diameter sized to fit inside abronchus of a patient and a length sufficient for a distal end of themain tube to reach a first side bronchus from a proximal end configuredto be located in a vicinity of a mouth of the patient, wherein thehollow main tube has a ventilating orifice separated from the distal endat a location that corresponds to a different second side bronchus; ahollow tubular sleeve moveably disposed inside and longitudinallyaligned with the main tube, the sleeve being configured to move, in alongitudinal direction, between a first position and a second positionwhile remaining disposed inside the main tube, wherein the sleeve doesnot block the ventilating orifice while in the first position and doesblock the ventilating orifice while in the second position; and an outerring coupled to, and disposed near, the proximal end of the main tube,the outer ring being configured to facilitate movement of the sleeverelative to the main tube.
 2. An apparatus as recited in claim 1,wherein an inner diameter of the sleeve is greater than 50% of the outerdiameter of the main tube.
 3. An apparatus as recited in claim 1,wherein an inner diameter of the sleeve is greater than about 80% of theouter diameter of the main tube.
 4. An apparatus as recited in claim 1,wherein the sleeve is displaced longitudinally toward the distal end inthe second position compared to the first position.
 5. An apparatus asrecited in claim 1, wherein the sleeve is rotated in the second positioncompared to the first position.
 6. An apparatus as recited in claim 1,wherein the sleeve is further configured to be positioned in a thirdposition that partially blocks the ventilating orifice.
 7. An apparatusas recited in claim 1, wherein the sleeve is configured to form anairtight seal at ventilating pressures with the main tube surroundingthe ventilating orifice when the sleeve is in the second position.
 8. Anapparatus as recited in claim 1, further comprising a bronchial cuffdisposed on the main tube between the distal end and the ventilatingorifice.
 9. An apparatus as recited in claim 8, wherein the bronchialcuff is inflatable.
 10. An apparatus as recited in claim 1, furthercomprising a tracheal cuff disposed on the main tube between theproximal end and the ventilating orifice.
 11. An apparatus as recited inclaim 10, wherein the tracheal cuff is inflatable.
 12. An apparatus asrecited in claim 1, further comprising an adaptor affixed to theproximal end of the main tube, wherein the adaptor is configured forattachment to a ventilation source.
 13. An apparatus as recited in claim1, wherein the main tube inner diameter is selected from a group ofdiameters comprising: 3.5 mm, 4.0 mm, 4.5 mm, 5.0 mm, 5.5 mm, 6.0 mm,6.5 mm, 7.0 mm, 7.5 mm, 8.0 mm, 8.5 mm and 9.0 mm.
 14. The apparatus ofclaim 1, further comprising: a connector attached to the sleeve, aportion of the connector being configured to pass through a slit in theouter ring and extend through the outer ring.
 15. The apparatus of claim1, further comprising: a connector attached to the sleeve, the connectorincluding two extensions, each extension being configured to protrudethrough a separate slit in the outer ring, wherein movement of the oneor both extensions within their respective slit facilitates movement ofthe sleeve relative to the main tube.
 16. The apparatus of claim 15,wherein at least one of the slits includes a plurality of notches thatengage the extension protruding therefrom and inhibit movement of theextension within the slit.
 17. The apparatus of claim 16, whereinmovement of the one or both extensions into a notch of the plurality ofnotches by an operator provides tactile feedback to the operator.
 18. Amethod for single lung ventilation, comprising: selecting an apparatuscomprising: a hollow main tube with outer diameter sized to fit inside abronchus of a patient and a length sufficient for a distal end of themain tube to reach a first side bronchus from a proximal end configuredto be located in a vicinity of a mouth of the patient, wherein thehollow main tube has a ventilating orifice separated from the distal endat a location that corresponds to a different second side bronchus; anda hollow tubular sleeve moveably disposed inside, and longitudinallyaligned with, the main tube, the sleeve being configured to move, in alongitudinal direction, between a first position and a second positionwhile remaining disposed inside the main tube, wherein the sleeve doesnot block the ventilating orifice while in the first position and doesblock the ventilating orifice while in the second position; and an outerring coupled to, and disposed near, the proximal end of the main tube,the outer ring being configured to facilitate movement of the sleeverelative to the main tube; causing the sleeve to be at the firstposition; inserting the distal end of the main tube into the bronchus ofa ventilating lobe of a lung of the patient so that the ventilatingorifice faces a bronchus of a different, operative lobe of a lung of thepatient; connecting the proximal end of the main tube to a ventilationsource; and using the outer ring to move the sleeve to the secondposition.
 19. A method as recited in claim 18, further comprising, afterinserting the distal end of the main tube, inflating at least one of aninflatable bronchial cuff disposed between the distal end of the maintube and the ventilating orifice or an inflatable tracheal cuff disposedbetween the proximal end of the main tube and the ventilating orifice.20. A method as recited in claim 18, wherein moving the sleeve to thesecond position further comprises moving an external structure at theproximal end of the main tube, wherein the external structure isconnected to the sleeve by a connecting element and is configured tomove the sleeve between the first position and the second position. 21.The method of claim 18, wherein the apparatus further comprises aconnector attached to the sleeve, a portion of the connector beingconfigured to pass through a slit in the outer ring and wherein movingthe sleeve to the second position further comprises moving the portionof the connector configured to pass through the slit within the slit.22. The method of claim 18, wherein the apparatus further comprises aconnector attached to the sleeve, the connector including twoextensions, each extension being configured to protrude through aseparate slit in the outer ring and wherein moving the sleeve to thesecond position further comprises moving one or both extensions withintheir respective slit.
 23. The method of claim 22, wherein the at leastone of the slits includes a plurality of notches that engage theextension protruding therefrom and inhibit movement of the extensionwithin the slit and wherein moving the sleeve to the second positionfurther comprises moving one or both extensions within their respectiveslit until the one or both extensions engages with its respective notch.24. The method of claim 23, wherein movement of the one or bothextensions into a notch of the plurality of notches by an operatorprovides tactile feedback to the operator.